Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 12597 | NE |
NPI | 1043244643 |
---|---|
Provider Name | Dr. Manju L. Patney |
First Address | Bellevue, NE 68005 |
Second Address | Bellevue, NE 68005-2977 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F09785 | (02) | NE |